Neuromonitoring and Assessment, An Issue of Critical Care Nursing Clinics of North America, E-Book

Catherine Harris

BOOK

Neuromonitoring and Assessment, An Issue of Critical Care Nursing Clinics of North America, E-Book

Catherine Harris

(2016)

Additional Information

Book Details

ISBN: 978-0-323-41644-3
Edition
Language: English
Pages: 153
Subjects: Neurology & clinical neurophysiology
Intensive care nursing
Medical study & revision guides & reference material

Abstract

Neuromonitoring is a broad term that essentially accounts for the essence of neuroscience nursing. Nurses working with critically ill, neurologically impaired patients should have a foundation in not only in invasive neuromonitoring, but the more subtle aspects of care. Nurses must understand that they are the most important tool in monitoring patients and interpreting the data. This issue of Critical Care Nursing Clinics will bring together the critical aspects of neuromonitoring in the intensive care units that can be used as a resource for nurses. Some articles included are devoted to Temperature Targeted Management; Refractory Intracranial Pressure Management; Blood pressure monitoring controversies; Invasive Neuromonitoring; Neuroradiology Review; Nursing Monitoring of Critically Ill Neurological Patients; Case Studies in EEG monitoring; and Neuromonitoring in the Operating Room.

Section Title	Page	Action	Price
Front Cover	Cover
Neuromonitoring and Assessment\r	i
Copyright\r	ii
Contributors	iii
CONSULTING EDITOR	iii
EDITOR	iii
AUTHORS	iii
Contents	vii
Preface: Neuromonitoring in the Intensive Care Unit\r	vii
The Bedside Nurse: The Foundation of Multimodal Neuromonitoring\r	vii
Blood Pressure Management Controversies in Neurocritical Care\r	vii
Delirium in the Neuro Intensive Care Unit\r	vii
Neuroradiology of the Brain \r	viii
Management of Refractory Intracranial Pressure\r	viii
Invasive Neuromonitoring\r	viii
Principles of Neuro-anesthesia in Neurosurgery for Intensive Care Unit Nurses\r	viii
Optic Nerve Sheath Diameter Ultrasound and the Diagnosis of Increased Intracranial Pressure\r	ix
The Use of Automated Pupillometry in Critical Care\r	ix
Cerebral Microdialysis\r	ix
Targeted Temperature Modulation in the Neuroscience Patient\r	ix
CRITICAL CARE NURSING\rCLINICS OF NORTH AMERICA\r	xi
FORTHCOMING ISSUES	xi
June 2016	xi
September 2016	xi
December 2016	xi
RECENT ISSUES	xi
December 2015	xi
September 2015	xi
June 2015	xi
Preface:Neuromonito\rring in the Intensive Care Unit	xiii
The Bedside Nurse	1
Key points	1
INTRODUCTION	1
GOALS OF CLINICAL MONITORING THROUGH NEUROLOGIC ASSESSMENT	2
STATE OF THE SCIENCE: ONGOING NEUROLOGIC ASSESSMENT IN THE NEUROSCIENCE INTENSIVE CARE UNIT	3
National Clinical Practice Guidelines	3
Clinical Monitoring and Outcomes	5
Clinical Monitoring and Adverse Outcomes	5
NEUROLOGIC MONITORING ASSESSMENT SCALES	6
ROLE OF THE CLINICAL EXAMINATION IN MULTIMODAL NEUROMONITORING	7
SUMMARY	7
REFERENCES	7
Blood Pressure Management Controversies in Neurocritical Care	9
Key points	9
INTRODUCTION	9
CONTROVERSIES IN MONITORING: NONINVASIVE OR INVASIVE BLOOD PRESSURE MEASUREMENT	10
CONTROVERSIES IN MONITORING: ARTERIAL TRANSDUCER PLACEMENT	13
CONTROVERSIES IN BLOOD PRESSURE MANAGEMENT: TREATMENT	14
RECOMMENDATIONS, FUTURE RESEARCH, AND TECHNOLOGICAL ADVANCES	15
SUMMARY	17
REFERENCES	17
Delirium in the Neuro Intensive Care Unit	21
Key points	21
WHAT IS DELIRIUM?	22
Delirium Motor Subtypes	22
INCIDENCE AND CONSEQUENCES	23
PATHOPHYSIOLOGY	24
Neuroinflammation Hypothesis	24
Oxidative Stress Hypothesis	24
Neurotransmitter Hypothesis	24
Neuroendocrine Hypothesis	25
Neuronal Aging Hypothesis	25
DELIRIUM ASSESSMENT	25
Step 1: Risk Factor Assessment	25
Steps 2: Pain Assessment	27
Step 3: Level of Consciousness—Sedation–Agitation Assessment	27
Step 4: Delirium Assessment	31
SUMMARY	31
REFERENCES	32
APPENDIX A	33
APPENDIX B	34
APPENDIX C	35
Additional delirium resources	35
Neuroradiology of the Brain	37
Key points	37
INTRODUCTION	37
ANATOMY OVERVIEW	38
Tissue	38
Arterial Vasculature	39
Venous Drainage	39
Ventricular System	40
DEFINITIONS	42
BASIC BRAIN IMAGING	51
Computerized Tomography Scan: Brain	51
Physics	52
Advantages/disadvantages	52
Advantages	52
Disadvantages	53
MRI: Brain	53
Physics	53
Diffusion-Weighted Imaging: Brain	54
Physics	54
Advantages/disadvantages	54
Advantages	54
Disadvantages	54
ADVANCED COMPUTERIZED TOMOGRAPHY/MRI/ANGIOGRAPHY IMAGING: VASCULAR	55
Computerized Tomography Angiography: Brain/Neck	55
Physics	56
Computerized tomography angiography	56
Magnetic resonance angiography	56
Contrast	56
Flow dependent	57
Flow independent	57
2-D and 3-D acquisitions	57
Computerized Tomography/MRI Venogram: Brain/Neck	57
Computerized Tomography/MRI Perfusion	57
Pathophysiology/physics	58
Computerized tomography perfusion	58
Magnetic resonance perfusion	59
Cerebral Angiography	59
Physics	60
Advantages	60
Disadvantages	60
Clinical applications	61
Computerized Tomography Imaging	61
Primary indications	63
Secondary indications	63
MRI	63
Angiography	64
SUMMARY	64
REFERENCES	64
Management of Refractory Intracranial Pressure	67
Key points	67
OVERVIEW	67
MANAGEMENT	69
INTERVENTIONS	70
Nursing Management During Period of Normal Intracranial Pressures	73
HYPERTHERMIA	73
Implications for Critical Care Nurses	73
SUMMARY	74
REFERENCES	74
Invasive Neuromonitoring	77
Key points	77
INTRODUCTION	77
RATIONALE FOR INVASIVE NEUROMONITORING	78
INDICATIONS FOR INVASIVE NEUROMONITORING	78
INTRACRANIAL MONITORING OPTIONS	79
Device Insertion	79
External Ventricular Devices	80
Intraparenchymal Monitors	81
ADVANTAGES AND DISADVANTAGES OF INVASIVE NEUROMONITORING	81
Brain Tissue Oxygen Monitoring	81
CONTROVERSIES IN INVASIVE NEUROMONITORING	82
Does the Evidence Support Practice?	82
Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure Trial	83
Intracranial Pressure Monitoring Alone Versus Multimodal Monitoring	83
SUMMARY	84
REFERENCES	84
Principles of Neuro-anesthesia in Neurosurgery for Intensive Care Unit Nurses	87
Key points	87
INTRODUCTION	87
PREOPERATIVE EVALUATION	88
INDUCTION CONSIDERATION	88
INTRAOPERATIVE CONSIDERATIONS	89
Positioning Concerns	89
Supine	90
Prone	90
Sitting	90
Padding	90
Neuromonitoring	90
Intracranial Pressure Management	91
Monitoring	91
Maintenance	91
Brain Relaxation Techniques	91
Fluids	91
SURGERY SPECIFIC CONSIDERATIONS	91
Craniotomy for Elective Aneurysm Clipping	91
Craniotomy for Subdural Hematoma	92
Spines	92
EMERGENCE FROM ANESTHESIA	92
Considerations	92
Complications	93
Postoperative Management	93
CONSIDERATIONS FOR THE INTENSIVE CARE UNIT NURSE	93
REFERENCES	94
Optic Nerve Sheath Diameter Ultrasound and the Diagnosis of Increased Intracranial Pressure	95
Key points	95
SUMMARY OF PROCEDURE	96
Review of the Literature	97
Implications for Clinicians	98
SUMMARY	98
REFERENCES	99
The Use of Automated Pupillometry in Critical Care	101
Key points	101
INTRODUCTION	101
NEUROLOGIC EXAMINATION	102
CRANIAL NERVES	102
PUPILLOMETER	103
DISCUSSION	104
SUMMARY	106
SUPPLEMENTARY DATA	106
REFERENCES	106
Cerebral Microdialysis	109
Key points	109
INTRODUCTION	109
USEFULNESS AND INDICATIONS	110
CATHETER PLACEMENT	110
DEVICE AND TECHNIQUE	112
ANALYTES	112
Glucose	112
Pyruvate and Lactate	113
Glutamate	115
Glycerol	115
DATA INTERPRETATION	115
INCREASED LACTATE LEVEL OR LPR GREATER THAN 25	116
Increased glutamate level	116
Increased glycerol level	116
SAFETY PROFILE	117
PREPARATION FOR CLINICAL APPLICATION	117
NURSING CONSIDERATIONS	117
SUMMARY	120
REFERENCES	120
Targeted Temperature Modulation in the Neuroscience Patient	125
Key points	125
INTRODUCTION	125
FEVER	126
HISTORICAL PERSPECTIVE	126
IMPLICATIONS FOR TARGETED TEMPERATURE MANAGEMENT	127
CLINICAL APPLICATION OF TARGETED TEMPERATURE MANAGEMENT	128
Traumatic Brain Injury	128
Elevated Intracranial Pressure/Intracranial Hypertension	128
Ischemic Stroke	130
Subarachnoid Hemorrhage	130
CONSIDERATIONS AND COMPLICATIONS	131
SUMMARY	134
REFERENCES	134

Neuromonitoring and Assessment, An Issue of Critical Care Nursing Clinics of North America, E-Book

Additional Information

Book Details

Abstract

Table of Contents

Contact Us

Quick Navigation